International Journal of Epidemiology, Vol 26, 662-669, Copyright © 1997 by International Epidemiological Association
RB Aylward, J Clements and JM Olive
BACKGROUND: The World Health Organization recommended strategy for
responding to measles outbreaks in developing countries does not promote
the use of immunization campaigns due to their high cost, disruptive nature
and limited impact. Given the substantial morbidity and mortality
associated with such outbreaks, a literature review was conducted as a
basis for re-evaluating this policy. METHODS: Reports of supplementary
immunization activities that were performed to control measles outbreaks in
middle or low income countries were identified. The impact of the
immunization activities on the course of each outbreak was evaluated by
examining the data provided. RESULTS: Of 66 reports detailing a measles
outbreak in a middle or low income country, 17 described supplementary
immunization activities which included seven 'non-selective' immunization
campaigns, three 'selective' campaigns and one use of an early 2-dose
schedule. Eight of the reports commented on the impact of the response,
five of which reported a reduction in outbreak morbidity. Only one of the
reports, from an isolated island outbreak, provided sufficient data to
support a possible reduction in outbreak-associated morbidity. CONCLUSIONS:
There are limited data on the impact of measles outbreak immunization
activities from developing countries. The available data do not support a
change in the WHO recommended strategy for conducting a limited, if any,
immunization response to such outbreaks. Immunization strategies which aim
to prevent outbreaks may be more effective than campaigns to interrupt
transmission of an outbreak which has already begun.
ARTICLES
The impact of immunization control activities on measles outbreaks in middle and low income countries
Global Programme for Vaccines and Immunization, World Health Organization, Geneva, Switzerland.
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